Withdrawal of life-support in paediatric intensive care - a study of time intervals between discussion, decision and death

<p>Abstract</p> <p>Background</p> <p>Scant information exists about the time-course of events during withdrawal of life-sustaining treatment. We investigated the time required for end-of-life decisions, subsequent withdrawal of life-sustaining treatment and the time to death.</p> <p>Methods</p> <p>Prospective, observational study in the ICU of a tertiary paediatric hospital.</p> <p>Results</p> <p>Data on 38 cases of withdrawal of life-sustaining treatment were recorded over a 12-month period (75% of PICU deaths). The time from the first discussion between medical staff and parents of the subject of withdrawal of life-sustaining treatment to parents and medical staff making the decision varied widely from immediate to 457 hours (19 days) with a median time of 67.8 hours (2.8 days). Large variations were subsequently also observed from the time of decision to actual commencement of the process ranging from 30 minutes to 47.3 hrs (2 days) with a median requirement of 4.7 hours. Death was apparent to staff at a median time of 10 minutes following withdrawal of life support varying from immediate to a maximum of 6.4 hours. Twenty-one per cent of children died more than 1 hour after withdrawal of treatment. Medical confirmation of death occurred at 0 to 35 minutes thereafter with the physician having left the bedside during withdrawal in 18 cases (48%) to attend other patients or to allow privacy for the family.</p> <p>Conclusions</p> <p>Wide case-by-case variation in timeframes occurs at every step of the process of withdrawal of life-sustaining treatment until death. This knowledge may facilitate medical management, clinical leadership, guidance of parents and inform organ procurement after cardiac death.</p

A genetic classification of caves and its application in eastern Austria

Based on existing classifications of caves that often involve descriptive terms, a classification is presented that is based purely on genetic processes. An attribute key is developed that allows the classification of caves by means of cave maps, photographs and reports. This method is applied to a dataset of 6007 caves in a study area in eastern Austria. The area comprises diverse geological units of the Eastern Alps and the southern Bohemian Massif. A total of 94% of the caves could be classified with the surprising result that mechanical weathering and erosion caves are almost as common as solution caves even though the vast majority of caves are developed in carbonate rocks. Field checks confirmed the result and showed that the error is acceptable. The classified caves can also be used as indicator of natural phenomena like gravitational mass movements or vulnerable karst areas by decision-makers non-specialized in cave genesis

Coupled numerical modelling of progressive failure in creeping constrained landslides under steady state and transient state conditions

ABSTRACT Creeping landslides are a threat to many mountainous communities. Some of these landslides are constraint either artificially or naturally and are slowing down. This slowing down might cause a false impression of safety even though a subsequent reacceleration of the landslide cannot be ruled out. Herein a numerical method is presented that can capture several features that have been observed in the creeping Brattas landslide which affects the ski resort town of St. Moritz. Extensive field observations and laboratory testing have revealed a variety of coupled phenomena, which are also common to other constrained landslides. A simple finite difference algorithm combined with a mechanical constitutive model is presented to simulate these phenomena along the entire slope. The model is based on the mechanism of progressive failure in a zone of intense shearing along the slip surface. Also the effect of rate dependent shear resistance is captured and two different rate dependency relations are analysed. Combining this mechanism with visco-elastic behaviour in the landslide body explains a phase of gradual slowing down of the landslide until 1991. Subsequent acceleration of the landslide can be described by visco-plastic yielding in a zone at the landslide foot where the pressure is close to passive earth pressure. Observed large differences in the velocity of the landslide between its upper and lower sections are attributed to secondary compression. The coupled numerical procedure is also capable of capturing not only the steady state behaviour but also the slope&apos;s reaction to precipitation (i.e. the transient state) by introducing a simple linear reservoir type model to relate changes in pore pressure to observed precipitation. The numerical procedure can be used for back-calculating parameters of the slope as well as for predictive purposes. These predictions indicate that further significant deformations in the constructed zone of the landslide have to be expected which makes additional observations and monitoring of sensitive structures essential. In combination with probabilistic models for exposures (e.g. development of precipitation and duration cold periods) the numerical model will also allow for proper risk analysis in the area affected by the Brattas landslide

The regulatory environment of the German over-the-counter (OTC) medicine market with regard to individual and social aspects

SIGLEAvailable from British Library Document Supply Centre-DSC:m01/40052 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Mehr Marktwirtschaft im Gesundheitswesen Ergebnisse einer Quantifizierung ausgewaehlter Reformvorschlaege

Bibliothek Weltwirtschaft Kiel A149,522 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Effects of Jak2 type 1 inhibitors NVP-BSK805 and NVP-BVB808 on Jak2 mutation-positive and Bcr-Abl-positive cell lines

Janus kinases are critical components of signaling pathways that regulate hematopoiesis. Mutations of the non-receptor tyrosine kinase JAK2 are found in many BCR-ABL-negative myeloproliferative neoplasms. Preclinical results support that JAK2 inhibitors could show efficacy in treating chronic myeloproliferative neoplasms. JAK2 has also been postulated to play a role in BCR-ABL signal transduction. Therefore, inhibitors of JAK2 kinases are turning into therapeutic strategies for treatment of chronic myelogenous leukemia (CML). In this study, the effects of two novel JAK2 inhibitors, NVP-BSK805 and NVP-BVB808, have been investigated in cell lines expressing either BCR-ABL or mutant JAK2. Possible synergies between NVP-BSK805/NVP-BVB808 and the kinase inhibitors imatinib and nilotinib were assessed. Proliferation and apoptosis tests with both substances showed response in the following cell lines: CHRF-288-11, SET-2 and UKE-1. All BCR-ABL-positive cell lines showed some reduction in proliferation, but with half-maximal growth-inhibitory values >1 {mu}M. Combination of the JAK2 inhibitors with imatinib and nilotinib showed no significant additive or synergistic effects, although all BCR-ABL-positive cell lines responded well to both CML therapeutic agents. Interestingly, it seemed that the combination of imatinib with NVP-BSK805 had a protective effect on the cells. Combination treatment with nilotinib did not show this effect